Survivorship FAQ

The information provided here is general in nature and should not be construed to be medical advice for specific health conditions or a substitute for professional medical care. If you have, or suspect you may have, a health problem, you should consult a licensed health care provider.

Dr. Gore specializes in urologic oncology and general urology at the University of Washington Medical Center.

What happens to my quality of life after my treatment for prostate cancer?

The impact of prostate cancer treatment on your quality of life depends on the type of treatment and the severity of your cancer. In general, treatment for localized prostate cancer that is confined to the prostate impacts your urinary function, bowel function, and sexual function. Most studies of quality of life in localized prostate cancer show minimal impact of treatment on general physical or mental health. The urinary problems men face after prostate cancer treatment range from urinary incontinence, or leakage of urine, to difficulty emptying urine from which patients experience increased frequency of urination, or urgency where one feels a rush to get to the bathroom. Urinary incontinence is more common after surgery with a radical prostatectomy. Emptying problems are more common after radiation. Sexual function is impacted because the erection nerves pass alongside the outer border of the prostate. And bowel function is impacted—most commonly by radiation therapy—because the rectum passes immediately behind the prostate. These areas of quality of life are more affected in men with more severe cancers, because the surgery may need to involve removal of the erection nerves, or the radiation field may not to be broader and cause more of an innocent bystander effect to the bladder or rectum.

How do I make sure the cancer does not come back?

The definition of cancer coming back, or recurrence, is based on the results of the prostate-specific antigen (PSA) test. A rising PSA after surgery or radiation therapy for prostate cancer usually indicates that the cancer has come back. The best way to monitor for a recurrence is to maintain follow up visits with your prostate cancer doctor at which time the PSA checks are usually scheduled.

Patients often ask about lifestyle changes they can make to try to keep their cancer from recurring. In general, we advocate regular exercise, maintenance of a low fat high fiber diet, and smoking cessation among active smokers.

How do I manage side effects?

Erectile Dysfunction/Impotence
Erectile dysfunction (ED) may respond well to different therapies and so one important aspect of managing ED after prostate cancer treatment is informing your prostate cancer doctor about your concerns. The options for management of ED include pills, the best known of which is Viagra, urethral suppositories, injections into the penis, vacuum devices to pull blood into the penis, and even surgery to place a prosthesis into the erection tubes. Your prostate cancer clinician can review these options with you to identify the best strategy that matches your concerns.

Incontinence/Urine Leakage
Urinary incontinence is most common after surgery to remove the prostate with a radical prostatectomy because the sphincter muscle sits close to the end of the prostate. One of the best treatments is time and patience, because most men continue to recover their continence up to 2 years after surgery. Most men also benefit from learning to do Kegel exercises to strengthen their pelvic floor muscles. In extreme cases, men may need surgery because these behavioral management strategies do not help enough, and in these cases your prostate cancer clinician can review your options. Some surgical options you may have heard about include the male sling or the artificial sphincter.

How often should I see my doctor?

The frequency of visits for prostate cancer patients depends on the stage of cancer you have and the treatment you are receiving. For men who were treated for localized prostate cancer with surgery to remove the prostate (radical prostatectomy) or radiation therapy, guidelines recommend that you have a PSA checked every 6-12 months. A common schedule is to have patients return to clinic every three months with a semiannual PSA check for the first two years after surgery or radiation therapy. That also provides for an opportunity to discuss any bothersome side effects of treatment that you may be experiencing, such as urinary incontinence or problems with erections. For patients with more advanced prostate cancer, the visits and the monitoring are usually more frequent.

What are your recommendations for maintaining health after cancer?

Prostate cancer can be a distracting diagnosis. What I mean by that is that a prostate cancer diagnosis can lead patients to forget about maintaining the other aspects of their health. Importantly, most men with prostate cancer die of other health problems, and the most common of these is cardiovascular disease. So regular checkups with your primary care doctor are critical to staying up-to-date with your preventive care, like getting regular lipid panel checks, blood pressure measurements, screening for other cancers such as colon cancer, and influenza and other vaccines. Exercise and a heart healthy diet are also important to maintenance of a healthy lifestyle.

What symptoms should I watch out for, which may mean my cancer has returned?

Usually, among patients that underwent surgery or radiation therapy for localized prostate cancer, the first sign that the cancer has recurred is that the PSA blood test begins to rise. After surgery, the American Urological Association (AUA) definition of a recurrence is a PSA rise to above 0.2 ng/mL that is confirmed on a second measurement. After radiation therapy, the American Society of Therapeutic Radiation Oncology (ASTRO) defines a recurrence as a rise of at least 2 ng/mL after the PSA has reached its lowest level. In the overwhelming majority of patients with a recurrence after surgery or radiation, there are no symptoms beyond the abnormal blood test. This highlights the need to be vigilant with regular checkups with your prostate cancer doctor for PSA tests.